Provider Demographics
NPI:1275077661
Name:TRUNKLE, LUCAS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:TRUNKLE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 MILLHOUS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2949
Mailing Address - Country:US
Mailing Address - Phone:301-331-6002
Mailing Address - Fax:
Practice Address - Street 1:300 KILDAIRE WOODS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5500
Practice Address - Country:US
Practice Address - Phone:929-254-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist